Journal Article

Predictors of 1-year outcome after coiling for poor-grade subarachnoid aneurysmal hemorrhage

Colonne, Chantal, Biondi, Alessandra, Lejean, Lise, Puybasset, Louis, Sanchez-Peña, Paola, Sourour, Nader, Boch, Anne L., Pereira, Ana R., Abdennour, Lamine

2007

Overview

To describe features in patients admitted to the intensive care unit (ICU) for poor-grade aneurysmal subarachnoid hemorrhage (SAH) and to identify predictors of 12-month outcome. We conducted a controlled observational study of 51 consecutive patients treated with endovascular coiling within 96 h of rupture for poor-grade aneurysmal SAH (20 men and 31 women, age 54 +/- 12 years). We recorded co-morbidities; initial severity; aneurysm location; occurrence of acute hydrocephalus, initial seizures, and/or neurogenic lung edema; troponin values, Fisher grade; computed tomography (CT) findings; treatment intensity; and occurrence of vasospasm. The brain injury marker S100B was assayed daily over the first 8 days. Glasgow Outcome Scores (GOS) were recorded at ICU discharge, at 6 and 12 months. The main outcome criterion was the 1-year GOS score, which we used to classify patients as having a poor outcome (GOS 1-3) or a good outcome (GOS 4-5). Overall, clinical status after 1 year was very good (GOS 5) in 41% of patients and good (GOS 4) in 16%. Neither baseline characteristics nor interventions differed significantly between patients with good outcome (GOS 4-5) and those with poor outcome (GOS 1-3). Persistent intracranial pressure elevation and higher mean 8-day S100B value significantly and independently predicted the 1-year GOS outcome (P = 0.008 and P = 0.001, respectively). Patients in poor clinical condition after SAH have more than a 50:50 chance of a favorable outcome after 1 year. High mean 8-day S100B value and persistent intracranial hypertension predict a poor outcome (GOS 1-3) after 1 year.

• Publisher: Springer Nature B.V
• Subject: Adult / Aged / Anesthesia / Aneurysms / Catheters / Critical Care / Embolization, Therapeutic / Female / Follow-Up Studies / Glasgow Outcome Scale / Hematoma / Hemodynamics / Hemorrhage / Humans / Hydrocephalus / Intracranial pressure / Ischemia / Male / Medical imaging / Middle Aged / Nerve Growth Factors - blood / Predictive Value of Tests / Proteins / Retrospective Studies / S100 Calcium Binding Protein beta Subunit / S100 Proteins - blood / Subarachnoid Hemorrhage - blood / Subarachnoid Hemorrhage - complications / Subarachnoid Hemorrhage - therapy / Time Factors / Tomography / Treatment Outcome